How Many Dental Implants and Stages is Best?
When a full set teeth replacement is required, certain dentists and specialists may often recommend six or more dental implants to support the prosthesis, and would undertake the treatment in multiple stages. All-On-4 is different in that only four fixtures are used to support the teeth, and the treatment is immediate with the final prosthesis being typically delivered within 24 hours of the surgery. So not only less implants are being used, but also these are immediately loaded, and the natural question arises are we pushing the limits? Would it be better to use more implants and to do it in stages?
Click here to get more info about: dental implants
Actually, the answer is quite the opposite. Staged, multi-implant systems have been around for many years, but the trend among experienced clinicians has been to use less implants and to undertake immediate loading with the ultimate aim of achieving a better outcome. So All-On-4 is actually a product of evolution (see History of All-On-4).
Nonetheless, All-On-4 is an advanced surgical and restorative oral rehabilitation system. It requires not only advanced skills and a great deal of experience, but also integrated dental, surgical and laboratory facilities. As such, not all dentists or specialists are, in fact, able to offer this treatment.
THE IDEAL NUMBER OF DENTAL IMPLANTS
The problem with full set implants is that the more implants we put in the more difficult it is for patients to clean around them because the implants are not actually visible. If you cannot clean them, then they will be smelly and will not last long.
More implants is also less comfortable for patients because of the increased number of screw access holes, which is additionally a known technical obstacle to achieving the best possible aesthetic result.
Four implants is ideal because there are two in the front and two in the back, and because of the way they are tilted not only do they provide the necessary support, but the spread also makes it more comfortable, more aesthetic, and much easier to know how to clean.
All-On-4 Immediate dental Implants
There are situations where we might consider placing one or more additional implants. This is very rarely the case in the lower jaw, but may be necessary in a small percentage of upper jaws depending on individual bone situations, biting pressures, and other parameters that we must take into account in our planning. Though in doing so we must always remain focused on our quality standards to ensure simple cleaning, optimal function, ultimate aesthetics and longevity. In some instances we may still be able to revert to using only four supports with a special kind of implants know as Zygomas, even when the jaw bone quality is extremely poor, because these actually rely on the cheekbones for support.
THE IDEAL NUMBER OF STAGES
Traditionally, implants were done over a number of stages where after surgery the patients were committed either to a denture or an unreliable temporary restoration until the permanent teeth can be fitted. Over the years numerous studies have shown that apart from being poorly fitting and uncomfortable for patients, these may actually cause inadvertent issues with the healing of the implants because of individual concentrated pressures from movement of the dentures or temporary restorations.
Immediate loading is a concept that emerged in the late 90’s to avoid or reduce the undesirable impact of a temporary restoration on the healing of the implants. In full arch rehabilitation, when the teeth are immediately and reliably connected to the implants, the biting pressures are shared and distributed between all the implants, which reduces the impact on individual implants and allows them to more freely and more reliably be integrated within the host bone. When immediate loading is undertaken, we often require our patients to be on a soft diet for 4 months, eating foods the consistency of fish, pasta, soft chicken, and avoiding things like nuts, apples, bones, bread crusts, and steak.
At All-On-4 Clinic our immediate teeth replacement system enables us to complete total rehabilitation within 24 hours of surgery with teeth that are final and which do not require subsequent replacement. The teeth are made from a uniquely designed metal-reinforced high-impact acrylic. Although permanent, these teeth will wear over time, and may need to be replaced at some stage. The longevity varies from patient to patient depending on the strength of their bite, the types of food they eat, or if they grind their teeth. We indicate an average longevity of 5 years because even though in many of our patients these teeth last for 10 years and longer, we also have cases where they last less than 5 years.
For more info visit here: dental implants brunswick
When its time to replace the All-On-4 implant teeth, the process is quite simple, non-costly and does not require any additional surgery or anaesthetic. At that time, the patient may elect to have the exact same kind of teeth, and thus expect similar longevity once again, or they might instead consider changing the teeth to a Zirconia material to improve durability and increase the expected longevity. The Zirconia is not going to look better than the original teeth, as we put a lot of effort to get it right in the first place, but they are just going to last much longer. As such it is unnecessary to upgrade to Zirconia before it is time to do so due to the wear and tear of the original teeth. Unfortunately it is not possible or desirable to fit the Zirconia teeth as an immediate restoration because of its weight and rigidity, which could have an impact on the integration of the implants during the initial four months of healing.
Smile like you dream
Following my last update, I was inundated with requests to put a face to the story, so here it is (with permission): the face that made our Christmas 2013!
The picture was taken at home 3 days after ‘all on 4 Plus’ rehabilitation using the new Zygoma Plus approach. Still bruised and swollen after surgery. It was sent to me as a text message from the boy’s mum:
For more info visit here: dental implants burwood
“Hi Dr Fibishenko, I managed to get a great shot of my boy so thought I would send it through to you and the girls! I’ve never seen him smile like that, he normally avoids it at all costs.”
How Many Dental Implants and Stages is Best?
When a full set teeth replacement is required, certain dentists and specialists may often recommend six or more dental implants to support the prosthesis, and would undertake the treatment in multiple stages. all on 4 dental implants is different in that only four fixtures are used to support the teeth, and the treatment is immediate with the final prosthesis being typically delivered within 24 hours of the surgery. So not only less implants are being used, but also these are immediately loaded, and the natural question arises are we pushing the limits? Would it be better to use more implants and to do it in stages?
Actually, the answer is quite the opposite. Staged, multi-implant systems have been around for many years, but the trend among experienced clinicians has been to use less implants and to undertake immediate loading with the ultimate aim of achieving a better outcome. So All-On-4 is actually a product of evolution (see History of All-On-4).
Nonetheless, All-On-4 is an advanced surgical and restorative oral rehabilitation system. It requires not only advanced skills and a great deal of experience, but also integrated dental, surgical and laboratory facilities. As such, not all dentists or specialists are, in fact, able to offer this treatment.
THE IDEAL NUMBER OF DENTAL IMPLANTS
The problem with full set implants is that the more implants we put in the more difficult it is for patients to clean around them because the implants are not actually visible. If you cannot clean them, then they will be smelly and will not last long.
More implants is also less comfortable for patients because of the increased number of screw access holes, which is additionally a known technical obstacle to achieving the best possible aesthetic result.
Four implants is ideal because there are two in the front and two in the back, and because of the way they are tilted not only do they provide the necessary support, but the spread also makes it more comfortable, more aesthetic, and much easier to know how to clean.
All-On-4 Immediate dental Implants
There are situations where we might consider placing one or more additional implants. This is very rarely the case in the lower jaw, but may be necessary in a small percentage of upper jaws depending on individual bone situations, biting pressures, and other parameters that we must take into account in our planning. Though in doing so we must always remain focused on our quality standards to ensure simple cleaning, optimal function, ultimate aesthetics and longevity. In some instances we may still be able to revert to using only four supports with a special kind of implants know as Zygomas, even when the jaw bone quality is extremely poor, because these actually rely on the cheekbones for support.
THE IDEAL NUMBER OF STAGES
Traditionally, implants were done over a number of stages where after surgery the patients were committed either to a denture or an unreliable temporary restoration until the permanent teeth can be fitted. Over the years numerous studies have shown that apart from being poorly fitting and uncomfortable for patients, these may actually cause inadvertent issues with the healing of the implants because of individual concentrated pressures from movement of the dentures or temporary restorations.
Immediate loading is a concept that emerged in the late 90’s to avoid or reduce the undesirable impact of a temporary restoration on the healing of the implants. In full arch rehabilitation, when the teeth are immediately and reliably connected to the implants, the biting pressures are shared and distributed between all the implants, which reduces the impact on individual implants and allows them to more freely and more reliably be integrated within the host bone. When immediate loading is undertaken, we often require our patients to be on a soft diet for 4 months, eating foods the consistency of fish, pasta, soft chicken, and avoiding things like nuts, apples, bones, bread crusts, and steak.
At All-On-4 Clinic our immediate teeth replacement system enables us to complete total rehabilitation within 24 hours of surgery with teeth that are final and which do not require subsequent replacement. The teeth are made from a uniquely designed metal-reinforced high-impact acrylic. Although permanent, these teeth will wear over time, and may need to be replaced at some stage. The longevity varies from patient to patient depending on the strength of their bite, the types of food they eat, or if they grind their teeth. We indicate an average longevity of 5 years because even though in many of our patients these teeth last for 10 years and longer, we also have cases where they last less than 5 years.
For more info visit here: dental implants malvern
When its time to replace the All-On-4 implant teeth, the process is quite simple, non-costly and does not require any additional surgery or anaesthetic. At that time, the patient may elect to have the exact same kind of teeth, and thus expect similar longevity once again, or they might instead consider changing the teeth to a Zirconia material to improve durability and increase the expected longevity. The Zirconia is not going to look better than the original teeth, as we put a lot of effort to get it right in the first place, but they are just going to last much longer. As such it is unnecessary to upgrade to Zirconia before it is time to do so due to the wear and tear of the original teeth. Unfortunately it is not possible or desirable to fit the Zirconia teeth as an immediate restoration because of its weight and rigidity, which could have an impact on the integration of the implants during the initial four months of healing.
All-On-4 Dental Implants Costs & Differences
Recently, where ever I turn I see dental advertisements for all on 4 dental implants treatment.
So what is it and is there a difference between various methods and the cost?
“All-On-4” is a treatment concept that has evolved over the past 20 years involving the placement of four and in some cases more, Titanium fixtures into either an upper or lower jaw and then placing a whole set of teeth on them. In many cases, the treatment can be completed within a day or so.
At All-On-4-Clinic Malvern, we have taken a great treatment concept and further improved and enhanced it. We use genuine Swedish ‘Nobel Biocare’ Implants and components that makes a big difference to the way the treatment is performed, as it was the Swedish company, Nobel Biocare that introduced the concept back in 2004 to experienced implant-surgeons like Dr Hillel New. The concept was improved and popularised in Australia by Dr Alex Fibishenko, who is founder of the brand and works together with Dr New.
As there is no registrable specialty dedicated to dental implants malvern, patients who are interested in having “All-On-4” treatment should be very mindful of the experience and skills of their surgeon, their training and the type of implants and components they are using, especially since this treatment is not simple to undo if done incorrectly. There are lots of dentists and dental specialist offering discounted All-On-Four type procedures using cheap implants and components enabling them to significantly cut back on costs and compete against those practitioners who are well trained and insist on only using genuine Nobel Biocare Products.
In addition, apart from the actual components, there is also the laboratory procedures that make a big difference to the All-On-4 Dental Implants Cost. Clinics under this brand use specially-trained technicians and produce an individualised lab-fabricated FINAL bridge, rather than just a cheap temporary bridge that will require replacement at a substantial cost in the future. One of the other problems with techniques involving the fitting of a temporary bridge, apart from being unreliable and difficult to clean, is the potential long-term affect on the health of the dental implants and bone loss. Click here for pictures and more information on the differences between the various methods.
For an Obligation Free consultation at a genuine “All On 4 Clinic”, call today to arrange a suitable time. Cosmetic Dental and Implant Centre is located in the Malvern area and services Melbourne’s inner south-east suburbs. Perhaps “All-On-4” is not appropriate for you……….in these situations we would be happy to discuss any of your cosmetic dental or Implant needs with you.
Dr Alex Fibishenko earns a standing ovation
The India International Dental Conference (IIDC) was held in Mumbai this year and was themed “Holistic Restorations With and Without implants”. Dr Alex Fibishenko was invited to present on solutions with Dental Implants, and specifically on the ‘All-On-4 Plus’ and ‘Zygoma Plus’ concepts that he spearheaded, and the treatment of highly atrophic jaws. Prof. Dr. Gunaseelan Rajan from Tamilnadu was appropriately appointed to moderate the session, having held some of the highest positions in the country including Presdient of Dental Council of India, President of Indian Dental Association, and a university Vice-Chancellor. He closed with a take home message for the 600 IIDC attendees saying, “Dr Fibishenko really summed up restoring the patient as a whole and not just the “teeth”. Some very nice points about the surgical design, and very importantly the contingency plans. Last but not least he showed what he can achieve with speed. A wonderful performance.”
It was an interesting choice for the organising committee to include Dr Fibishenko under the “Hollistic” banner. His philosophy, concepts and the systems that Dr Fibishenko adheres to in oral rehabilitation and dento-facial surgery do not on the surface appear as being “holistic” or conservative. But his presentation proved quite the opposite as time and time again Dr Fibishenko emphasises that “we need to provide our patients with a definitive plan …because implants are not reversible. They are difficult to undo and often impossible re-do. So as clinicians, especially in an era of pressures from the expectation of instant gratification, we must do what is necessary to ensure predictable aesthetics, long term function, simplified hygiene, and contingency options. We treat persons who have needs, desires, hobbies, skills, talents and social lives. We treat individual people, not just “teeth” or “jaws”, and we must recognise that what we do, especially with dental implants, could potentially impact their lives in a positive way, or quite the opposite. What we do not want to do is to replace one problem with deteriorated teeth or dentures, yet with another problem with implants. We need to provide a solution, not merely a treatment concept.”
Patient don’t want ‘Implants’! A Synopsis by Dr Alex Fibishenko
The edentulous, or those soon to be edentulous, are oral invalids who can be rehabilitated with dental implants. The trend has been to use less and less implants in total rehabilitation, and immediately load them. In doing so the question is: are we pushing the limits, or simply providing the product of evolution in this field?
Osseointegration is the single most researched topic in dentistry today. In 2004 the American Dental Association has reported that “the average survival rates of multiple implant designs placed in various clinical situations are more than 90%”. They also reported findings that implants may provide a “more predictable outcome” than alternative therapies [Stanford C, Rubenstein J. Dental endosseous implants-an update. ADA Council on Scientific Affairs. Journal of the Americal Dental Association 2004; 135:92-95]. Review of some of the current literature suggests survival rates in the vicinity of 97% to 98.5%. These figures are more favourable than almost any other day-to-day procedure we perform.
However, we have long passed the development phase of implant therapy where restoring function and ensuring implant ‘survival’ were central. In todays society, these criteria alone are no longer acceptable on their own. Function, aesthetics and long-term oral health parameters must all go hand in hand as implant ‘Survival’ is not necessarily synonymous with Implant ‘Success’, just as a cosmetic procedure is not necessarily an aesthetic one. We know the implants will survive, we now need to make them ‘successful’.
Whilst dextrous accuracy and following surgical and prosthetic protocols are paramount in implant therapy, these will always be secondary to sound treatment planning. As clinicians in the era of ‘aesthetics and high expectations’, we must think beyond the square, beyond the ‘teeth’. We must recognise that at the tip of the scalpel is a person, – people with personalities, talents, hobbies, and social lives, and whose lives can be altered one way or the other with the treatment we provide.
Patients who need dental rehabilitation prefer a quick ‘makeover’ …a concept certain dental professionals traditionally resisted due to a perceived potential compromise to quality and longevity as well as complex co-ordination and set-up requirements. But what if a quick makeover was in fact the treatment that offered the better aesthetics, quality and longevity as well as facilitating oral hygiene, such as the case with All-On-4 Plus®? Then the only obstacle may lay in our ability to deliver!
We must recognise that patients don’t want ‘Implants’, they come to us because they want a beautiful smile, to be able to enjoy all foods and desiring uncomplicated options in the event of the unforeseen.
The modern challenge of total rehabilitation lies in providing a functional and aesthetic rehabilitation which at the same facilitates long term oral health and improves the longevity of our supra-structures. all on 4 perth Plus® addresses this challenge through indication-specific treatment planning incorporating Dr Fibishenko’s internationally acclaimed innovative techniques that have a built-in contingency and facilitate the delivery of an immediate FINAL restoration in the most streamlined process.
The quality of our treatment planning is in the end judged through our ability to differentiate or synchronise what is possible and what is practical and predictable; as well as our ability to draw on what we know, recognise and learn what we still don’t know, and be mindful of those things we don’t know that we don’t know.
“Its the things that appear ‘simple’ that require the highest degree of sophistication” – Dr. Alex Fibishenko
The lecture by Dr Alex Fibishenko was dedicated as a tribute to and in memory of Professor P I Branemark who recently passed away.
Dental Implants Costs: Annual Review
The All-On-4 Clinic annual national conference was held yesterday at the brand’s headquarters in Melbourne. Key personnel attended representing their clinics from around Australia. It was an forum to review our systems, and the motto was ‘Changing the lives of everyday people every day’, which by pure chance coincided with a recent tweet about the same by Sir Richard Branson:
Making a difference in people's lives with review Dental Implants Costs
In a touching story we published a year ago about the potential impact of what we do on peoples lives, we uncovered an emotional journey of a boy born with no tooth buds, who went through his childhood and early adulthood dealing with the social disadvantages of having no teeth, finally ending up at our clinic and being fitted with normal functional teeth. Read more about his journey, and put a face to his story in the subsequent article Smile Like You Dream.
We know that we have made a difference in the lives of thousands with the All-On-4 treatment, and we will continue with the work that we do, but in the next chapter of our business we also want to create a legacy by making what we do more accessible and affordable to many more people. So the agenda of the annual meeting was altered to include a review of the dental implants costs.
With the rise in the demand for the All-On-Four treatment in Australia, there has also been a rise in ‘imitation’ treatments, for a lack of a better word, at costs below 20K per arch that we see as being aimed to capitalise on the popularity of our methods, in many cases without the patients being made fully aware of the differences. We have all heard about those cheaper clinics, and whilst we have a highly competitive pricing policy, we need to ensure we always compare apples with apples. We prefer to maintain our high standards and not just compete, but be the leaders in terms of value. And when we say ‘value’ we don’t just mean in our service, but a measurable difference in what our patients actually get.
Dr Hillel New, from our Malvern clinic, recently published an interesting article on the topic entitled All-On-4 Dental Implants Costs & Differences.
Typically, the average All-On-4 dental implants sydney using our methods costs approx. $25K. This price has not changed in 5 years and was set in accordance with All-On-4 Clinic’s competitive pricing policy at the time. The question at our annual review was whether we can we make it even cheaper to make it more affordable and more accessible to more people?
One of the things that we had to take into account in our fee review was the fact that what we offer is quite unique, not just terms of our facilities, but also in our methods and focus. Simply put, we do it differently. One of the differences is that we deliver the FINAL teeth typically within 24 hours. We have an onsite laboratory and methods that are proprietary to All-On-4 Clinic brand, which enable us to deliver on our promise time and time again. These are NOT some temporary make-shift teeth, or pre-fabricated dentures that are hollowed out and retro-fitted to the fixtures. Using those latter methods would certainly make the initial treatment much cheaper, but the the lack of reliability and fragile nature of such methods means that there will need to be a more permanent bridge made at some point in the near future, at an additional fee, leading to a far greater overall cost. However, apart from the overall dollar value, there is also the biological cost and oral health implications by using such alternative non-definitive methods. Apart from difficulties to clean and maintain the teeth, in using cheaper methods there are numerous other compromises that often lead to a deterioration in the health of the bone around the fixtures, or even failures. The problem is that this treatment, when the problems become known, is complex to undo and often impossible to re-do.
Taking into consideration the comparative value of what we offer, especially in the face of raising costs of components and skilled personnel, there was a push to do the opposite and raise our rates by 10%-15%. However in the interest of our revised motto to make it more affordable and more accessible in 2015, we resolved to keeping our prices the same as they have been for a further period of 12 months whilst maintaining our standard without compromise .
Another topic of discussion when it came to a review of our fees was a promotion that we ran in 2013 for Porcelain-Zirconia teeth upgrade. The fees for a full set of Zirconia-Porcelain teeth is typically $22K. The promotion was a full set for $8,800 for the first 80 patients who registered. The uptake was overwhelming, and we have since negotiated with our CAD-CAM Zirconia laboratory extended arrangements that now enable us to offer the reduced pricing ALL our patients, new and old. This pricing is only available to patients who received their surgical treatment at the All-On-4 Clinic.
Finally, in keeping with our competitive pricing policy, we produced a closing statement in summary of our position on Dental Implants Costs:
At All-On-4 Clinic we are committed to helping change the lives of everyday people every day. We acknowledge that an extension of our commitment includes providing a service that is accessible and affordable to more people. We are also committed to maintaing our high standards without compromise and to providing our patients with predictable results and a streamlined process. Nevertheless, we strive to remain competitive when it comes to the cost of dental implants and All-On-4, and to be leaders in terms of value. To that effect, if we come across a cheaper fee from similarly experienced clinicians who use the same Swedish implants (Nobel Active by Nobel Biocare) and the same processes and FINAL teeth, and who work to the same quality standards, we will not only match that price, but will revisit our pricing structure entirely. – Team Statement
At the All-On-4 Clinic, we know that we offer the most competitive price for the type of treatment that we offer. We know this because with 10 facilities across Australia and New Zealand, we can pass the savings from bulk purchases of components and laboratory production to our patients. We also do it quicker than less experienced operators, which again plays into our ability to keep prices at the lowest possible level.
